Healthcare Provider Details

I. General information

NPI: 1114082203
Provider Name (Legal Business Name): VICTOR L OBRYAN PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2011 CHURCH ST SUITE 501
NASHVILLE TN
37203-2000
US

IV. Provider business mailing address

2011 CHURCH ST SUITE 501
NASHVILLE TN
37203-2000
US

V. Phone/Fax

Practice location:
  • Phone: 615-340-4677
  • Fax: 615-284-4679
Mailing address:
  • Phone: 615-340-4677
  • Fax: 615-284-4679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberP401
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: